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PLAIN 100 MILE ENDURANCE RUN
September 8-9, 2012
Plain, Washington

    Registration Form & Waiver(type, sign, and mail)

    First Name: Age:

    Last Name:   Male Female               

   City: State:     Zip:

   Emergency Phone:   Your Phone:

   Medical Conditions:

    E-Mail Address:

    Pre Race Dinner Yes   No   Number of Guests@$10 pp:

    Qualifying Race Name/Date:      Time:

COST
(Payable to Cascade Running Club):

Cost: $95 per person for race, $10 per guest for dinner. Registrations may be accepted beyond September 1, subject to availability. Cancellation: prior to September 1, $90 refund. After September 1, no refund.
Deposit enclosed $

Please read the following before signing - WAIVER: In consideration of your accepting this entry, I hereby for myself, my heirs, and executors, waive any and all claims that I may have against any and all persons and organizations affiliated with this event, including but not limited to organizaers and supporters, USATF, PNTF, Cascade Running Club and any sponsers, while traveling to or from and participating in the Plain 100 Mile Endurance Run.

    Signature :   ___________________________________________________________

    Date: _______________________________

Return Entry with Payment by 8/31/12 to:
Cascade Running Club
PO Box 218, Kirkland, WA 98083-0218